MEDICARE: DR. MARK W FAGAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	11964	MD

General Provider Information

NPI Number	:	1588612790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK W FAGAN DDS

Provider Business Mailing Address
First Line	:	120 MILL CREEK LN
Second Line	:
City	:	SACKETS HARBOR
State	:	NY
Zip	:	13685-9744
Country	:	US
Telephone Number	:	915-841-8661
Fax Number	:

Provider Business Practice Location Address
First Line	:	10205 N RIVA RIDGE LOOP
Second Line	:
City	:	FORT DRUM
State	:	NY
Zip	:	13602-5457
Country	:	US
Telephone Number	:	315-772-5088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/30/2022

Similar Medicare Providers

1164637112 — GUTHRIE AHC
Practice Location Address:

10205 N RIVA RIDGE LOOP , SUITE P36
FORT DRUM, NY
13602-5457

Practice Phone: 315-772-2778
Practice Fax:

1093920811 — GUTHRIE AHC
Practice Location Address:

10205 N RIVA RIDGE LOOP , SUITE P10506
FORT DRUM, NY
13602-5457

Practice Phone: 315-772-2778
Practice Fax:

1457556136 — GUTHRIE AHC
Practice Location Address:

10205 N RIVA RIDGE LOOP , SUITE P10205
FORT DRUM, NY
13602-5457

Practice Phone: 315-772-8891
Practice Fax:

1851650287 — MRS. JESSICA MARIE SOUTHEARD R.D.H
Practice Location Address:

10205 N RIVA RIDGE LOOP
FORT DRUM, NY
13602-5457

Practice Phone: 315-772-8843
Practice Fax:

1164606224 — DR. MARK E. SWIGERT D.C.
Practice Location Address:

30941 MILL LN STE B
SPANISH FORT, AL
36527-5457

Practice Phone: 251-459-0098
Practice Fax:

1932454006 — MEFL, LLC
Practice Location Address:

5457 N FEDERAL HWY
FORT LAUDERDALE, FL
33308-3206

Practice Phone: 954-776-5949
Practice Fax: 954-776-5951

Directions to “ DR. MARK W FAGAN DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.